Despite the availability of effective antiretroviral therapy, more than half of people living with HIV are not engaged in regular outpatient HIV care. Consequently there is increased need to improve engagement and retention in care. Dr. Baligh Yehia is a postdoctoral infectious diseases fellow at the University of Pennsylvania. His long-term career goal is to conduct research that informs clinical practice and national policy for persons living with chronic viral diseases. The overall purpose of this K23 proposal is to train Dr Yehia for a career as an independent investigator. His plans for development into an independent investigator include gaining competency in analysis of longitudinal cohort data, implementation and analysis of qualitative research, understanding patient behaviors and adherence practices, and evaluation of health care delivery models. He will benefit from an outstanding mentoring team lead by Drs. Joshua Metlay, Kelly Gebo, and Karen Glanz, who have extensive experience in conducting health services, quality of care, and health behavior research. These experiences will occur within the rich research environment offered by the University of Pennsylvania. Improving retention in care is critical to receiving antiretroviral therapy, lowering HIV transmission, and reducing health care costs. This proposal intends to advance the science of patient adherence to outpatient care and seeks to identify health system and patient factors influencing retention in care, with the ultimate goal of improving health care quality for persons living with HIV. To accomplish this goal, three studies will be pursued to: 1) determine the relationship between patterns of retention in outpatient HIV care and clinical outcomes~ 2) develop and administer two surveys that will assess environmental and patient factors that may impact patterns of retention in outpatient HIV care~ and 3) identify environmental and patient factors associated with patterns of retention in outpatient HIV care. These studies test relationships between patient factors, environment factors, health behaviors, and outcomes identified in Anderson's Behavioral Model. A mixed methods approach will be used, combining quantitative (retrospective and prospective clinical cohorts) and qualitative (patient interviews and survey development and implementation) methodologies. At the competition of this project, Dr. Yehia will be trained as an independent investigator working to improve HIV health care quality, and will embark on future studies developing a predictive model to identify patients at risk of disengaging from care and testing interventions aimed at improving linkage to and retention in outpatient HIV care. PUBLIC HEALTH RELEVANCE: Engaging and retaining HIV-infected individuals in care is essential for prolonging life, decreasing HIV transmission, and avoiding HIV-associated complications. This research will evaluate outcomes of varying patterns of retention in outpatient HIV care and identify patient and health system barriers to retaining patients in continuous medical care. With this knowledge, predictive models to identify patients at risk of disengaging from care and interventions focused on addressing barriers to care can be implemented.